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Faecal Sludge Management – Performance Monitoring Survey 2017
1 | P a g e
‘000’ if no number
HOUSEHOLD SURVEY QUESTIONNAIRE (Annex-1) Code:
Date of interview: ..../ ...../ 2017 Time record: ................Hrs. (start of interview)
town
ward
sample number (ward-wise)
BUILDING INFORMATION
B1
Name of the Interviewee
B3
Total number of families
in the building:
B2 Position of the Interviewee:
Owner ...................1
Caretaker/guard ...................2
Tenant............. 3
Others (Specify)............. 4
B4
B5
Total Number of Containment in the building:
Septic Tank:
Pit:
HOUSEHOLD INFORMATION
HH1 Name of the Interviewee HH2
HH3
Age (Year) of the respondents
Sex: Male......1 Female....2 Other.... 3
HH4
HH5
HH6
Plot No.:____________
Holding No:___________
Name of the road or number ....................
............................... .............................
Area ..............................................
HH7 Type of household:
Planned residential area ...................1
Unplanned residential area ...................2
Slum located on private land............. 3
Slum located on government land .........4
HH8 This floor: [for ground floor ‘1’] HH9 Total floor in this building/ house
[including ground floor]
HH10a
HH10b
Name of head of household:
----------------------------------------
Sex: Male......1 Female....2 Other.... 3
HH11 Relationship between the head and the
Interviewee
Self .................1 Spouse..........2
Son/daughter ......3 Others
..............4
HH12 Profession of the HH owner(Code)*:
HH13 Religion of the head of this household:
Islam ..........1 Hindu .........2
Christian .........3 Buddhist ..........4
Other religion ...5 No religion .......6
HH14 DO YOU OR SOMEONE IN THIS HOUSEHOLD
OWN THIS DWELLING, OR DO YOU RENT
THIS DWELLING?
Own (both land & house).................1
Rent (both land & house) ...................2
Land rented, but own house ............5
Rent free other ................................4
HH15 How many years do you live in this
property /land? Years
HH16 Width of the access road
to the dwelling (feet) :
HH17 Total household members
HH18a Number of male aged under 5 HH18b Number of female aged under 5
HH19a Number of male aged 5-18 HH19b Number of female aged 5-18
‘000’ if no number
Faecal Sludge Management – Performance Monitoring Survey 2017
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*Service ......1 Business (medium and large)........2 Small business ....3, Student........4, driver .......5,
Day labourer/ rickshaw pooler ......6, No regular job .....7, Housewife ......8, others ........9
SANITATION
1(S) Does your household have a
toilet?
No facility, practice open defecation ........1
No, use neighbour’s toilet .................2
Yes, have own toilet ............................3
Yes, have community toilet ................4
Yes, share a toilet by 2 - 3 households ...5
1,2 Next
Section
2(S) How many toilet cubicles does
the toilet have?
3(S) How many households in total use
this toilet facility, including your
own households?
Number of households
If reply ‘Don’t know’ please put (98)
4(S) Are all the toilet cubicles being
used as toilet?
<Question> and
observation>
Yes ……………………………………….......……………. 1
No……………………………………………….........…2
1 6(S)
5(S) How many of them are not
being used?
<Question> and
observation>
6(S) Are they segregated for male/
female users?
<Question> and
observation>
Yes ……………………………………….......……………. 1
No……………………………………………….........…2
2 8(S)
7(S) How many cubicles for female and
how many for male?
<Question> and observation>
Only for female:...
Only for male: ...............
Share by female and male: ...........
8(S) Do the excreta from your
toilet go to a covered pit or
septic tank?
<Question> and
observation>
Yes ............... ........... ........................1
No ........................................................2
Don’t know .........................................3
HH20 Number of male aged 18-60 HH21 Number of female aged 18-60
HH22 Number of male aged over 60 HH23 Number of female aged over 60
HH24 Does anyone in your household have difficulty in walking or climbing steps? Yes .....1 No .......2
(Physical disability)
HH25 Does anyone in your household have difficulty in seeing? Yes .....1 No .......2
HH26
HH27
Do you feel secure from eviction from this
dwelling?
Yes .....1 No .......2 Don’t know ......8
Not Applicable ......88
Have you been evicted from your home at
any time during the past 5 years?
Yes .....1 No .......2 Don’t know ......8
Not Applicable ......88
HH28 Is the cooking usually done in the house, in
a separate building, or outdoors?
Own separate kitchen inside the house .....1
In the house, but no separate kitchen ........2
Kitchen outside the house but in a separate
building (own) ......................................3
In a common kitchen outside the house ....4
Other (specify) ................................ 9
Faecal Sludge Management – Performance Monitoring Survey 2017
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9(S) How do you flush to clean
your toilet pan after
defecation?
<Question> and
observation>
No flush required ..............................1
Pour flush .............................................2
Automatic flush .................................3
10(S) What type of toilet do you use?
<Observation>
Hanging latrine ..................................1
Direct open pit/ pit without cover .......2
Latrine conected to open spcae or drain ..3
Do’t know where it goes after flush ....4
Bucket latrine .....................................5
1-5 Next
section
Covered Pit latrine ..........................6
Pit latrine with covered slab and pan .......7
Ventilated Improved Pit Latrine ...........8
6-8
11(S)
Septic tank ............................................9 9 21(S)
Sewer system ...................................10
Composting toiulet (Eco-san toilet) ...11
DEWATS ...........................................12
Bio-gas plant .................................13
10-13
25(S)
Others (specify) ................................99
11(S) How many pits are there and
How are they placed?
<Observation>
Direct single pit ..................................1
Offset single pit ....................................2
Double pit (without ‘Y junction’)............3
More than 2 pits ..................................4
Twin pit (with ‘Y junction’) .................5
1-4
13(S)
12(S) Whether the ‘Y Junction’ of the
twin-pit latrine functional?
<Observation>
Yes ……………………………………….......……………. 1
No……………………………………………….........…2
13(S) Size of the pit
<Question> and <observation>
Diameter: ............ Inches
Total number of rings (of all pits): ..........
14(S) Materials of the rings Cement ................................................1
Clay ................................................2
No rings, only pit ....................................3
Don’t know ......................................8
15(S) When the pit was dug, was any
groundwater seeping in?
Yes .....................................................1
No ..........................................................2
Don’t know/ don’t remember ..................9
16(S) Are the walls of the Pit completely
sealed?
Wall not cement lining ...........................1
Part of wall cement lining ...................2
Wall cement lining ................................3
No ring ............................................4
Don’t know .............................................8
17(S) Are the bottom of the Pit
completely water sealed?
Only mud................................................1
Only brick soling................................2
Cement Concrete ....................................3
Don’t know .............................................8
18(S) Are all the rings of the pit placed
below ground? <Observation>
All rings above ground............................. 1
Partly above ground........................... 2
All rings below ground ............................ 3
No ring .............................................4
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19(S) Is there a Vent pipe from the
pit to the air outside?
<Observation>
Has a vent pipe 1
No vent pipe 2
20(S) Distance of nearest water
body from the pit (in feet)
<Observation>
feet
25(S)
21(S) How many chambers do the
Septic Tank have?
<Question> +
<Observation>
One chamber ..................................1
Two chambers ..............................2
More than two chambers....................3
Could not identify...........................8
22(S) What is the size of the Septic
Tank?
<Question> + <Observation>
Length (feet):
Width (feet):
Height (feet):
Could not measure .............................. 8
23(S) Is there any soak pit/well
connected to the septic tank?
<Question> + <Observation>
Yes ...................................................1
No..........................................................2
Don’t know ........................................8
1, 8
25(S)
24(S) If the soak pit/well is not
available, where does the
liquid/sludge go?
Pipe outlet to open ground .....................1
Pipe outlet to surface or grey water drain .....2
Pipe outlet to sewer ...............................3
Don’t know...............................................8
Others (mention) ....................................9
25(S) When was the Septic Tank/Pit/
treatment plant constructed?
Years ago
If ‘Don’t know’ please, mention ‘99’
If less than one year, mention ‘01’
26(S) Was your septic
tank/pit/treatment plant built
together with your building?
Yes ........................................................1
No ......................................................2
Don’t know...............................................8
27(S) Is your toilet have arrangement
for water seal?
<Observation>
Yes ........................................................1
No water seal, but toilet pan is covered.....2
No water seal, & toilet pan is not covered .....3
2,329(U)
28(S) Whether the water seal of the
latrine pan is functional?
<Observation>
Yes, functional ......................................1
No, water seal broken/ no water is visible.....2
No, Water seal is blocked ........................3
29(S) Is the cover of the pit or manhole
of the septic tank open?
<Observation>
Yes ............... ....... ....... ..................1
No ................................. ....... ....... .......2
30(S) How close is the water supply to
the latrine?
<Observation>
Running water inside the cubicle ............1
Stored water inside the cubicles .................2
Within (community) latrine block ............3
At (community) latrine block perimeter........4
Within plot/ yard..................................5
Beyond plot/ yard ...............................6
Carry from home house............................7
Others (mention) .................................9
31(S) Can you use this toilet facility at
all hours of the day and night?
Yes ....................................................1
No..........................................................2
133(U)
Faecal Sludge Management – Performance Monitoring Survey 2017
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32(S) What are the reasons for not
getting access to toilet at all
hours of the day and night?
Feel insecure in the night ..................... 1
Far away from houshold ...........................2
Pathway become sleepy during rain .......3
Long queue ............................................4
Others (specify) .................................9
33(S) Is the door lock of the toilet
(inside) functional?
<Observation>
Yes .......................................................1
No ....................................................2
34(S) Do you feel secure while you are
in the toilet?
Yes .......................................................1
No.................................... .................2
35(S) How often does the latrine get
cleaned?
Everyday ................................................1
Every week, often (4-6 times) ...............2
Every week, seldom (1-3 times) ................3
Not every week ...................................4
Almost never .............. ...........................5
Do not know .......................................8
36(S) Who usually does the cleaning of
the latrine?
Male family members ............ .................1
Female family members ...... ................2
Male and Female together ................. ......3
Female house servant ..........................4
Male house servant ..................................5
Paid cleaner/ caretaker .........................6
Don’t know .............................................8
37(S) Are there any cleansing / sanitary
materials left on the floor?
<Observation>
Yes .......................................................1
No ...........................................................2
38(S) Is there any faecal smears visible
in/on pan or floor of the toilet?
<Observation>
Yes .......................................................1
No ...........................................................2
39(S) [For the HHs who have child under
5]
Where are the children’s excreta
disposed off?
Defecated in the toilet ...............................1
Dispose into the toilet .............................2
Dispose with the solid waste .......................3
Through in the drain or nearby places .......4
Don’t know ...............................................8
Others (specify) ......................................9
40(S) Is excreta seeping (visible) from
the pit/ septic tank/ sewerage/
DEWATS/ Biogas plant?
<Observation>
Yes .......................................................1
No ...................................................2
41(S) Is bad smell come out from the pit/
septic tank/ sewerage/
DEWATS/Biogas plant?
<Observation>
Yes ...............................................1
No ...........................................................2
42(S) Can everyone in the household
presently use the toilet easily and
conveniently unassisted?
Ring all that apply
Yes No N/A
A. Old age .......................1 .........2 ........3
B. Physically disabled........ 1 .........2 ........3
C. Can’t see ................... 1 .........2 ........3
D. Pregnant women .........1 .........2 ........3
E. Menstruating women..... 1 .....2 ........3
F. Small children ............. 1......2 ......3
Faecal Sludge Management – Performance Monitoring Survey 2017
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G. Other (specify) ........... 1 .........2 ........3
43(S) Do you have any problems using
your toilet?
Ring all those that apply
No problems .......................................... 00
Not clean.......................................... 01
Smelly ................................................. 02
No water inside the toilet ................... 03
Not easy to reach toilet (long distance) ..... 04
Not easy to squat/ afraid of falling or slipping
....................................................... 05
Not easy to wash yourself................. 06
Not easy to flush.................................. 07
Too small....................................... 08
Too dark.............................................. 09
No privacy......................................10
Insects and animals inside .....................11
Other (specify)................................99
44(S) Do you have any problems
cleaning and maintaining your
toilet?
Ring all those that apply
No problem .................. ..................00
Excreta in the toilet pan .........................01
Toilet blocks often ............................02
Water not available to clean ...................03
Cleaning materials not available ...........04
Don’t know how to clean ........................05
Other users don’t know how to use........06
Too many users, difficult to keep clean .....07
Other users don’t take their turn to clean.....08
Design is difficult to clean.......................09
Other (specify) ............................... 99
45(S) How much do you spend for O&M
of toilet per month and for what
purposes (excluding pit/ tank
emptying)?
Taka:
Purpose :
Cleansing materials ............................1
Minor repair ...................................2
Others (mention) ...............................9
46(S) Who in the household makes
decisions about building,
upgrading or maintenance of the
toilet pit which you use?
Landlord / office (staff quarter) ..............1
Landlord/ office and tenants together......... 2
Tenants only ..................................... 3
Others (mention) .....................................9
47(S) What gender are the main
decision makers about building,
up-gradation or maintenance of
the toilet pit?
Women ................................................. 1
Men.................................................. 2
Women and men together....................... 3
48(S) Did you or any one requires any
permission for construction of the
septic tank?
Yes permission taken ............................1
No permission taken .........................2
No Permission required ...........................3
Don’t know ..............................................8
2,3,8
50(S)
49(S) If yes, from which Authority? KCC/Paurashava .....................................1
KDA .........................................................2
Don’t know ...........................................8
Others (specify)........................................9
Faecal Sludge Management – Performance Monitoring Survey 2017
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50(S) Whether any one visited your
house to inspect the Septic Tank
during or after construction of
toilet?
Yes .....................................................1
No ..........................................................2
Don’t know ............................................9
HANDWASHING
1(H) Where members of your
household most often wash their
hands after defecation?
No specific station for hand washing ...........1
Inside the toilet ....................................2
Outside toilet cubicle but inside toilet
(community) block ............................3
Outside toilet but inside the house ............4
Outside the toilet (community) block, at water
points ...............................................5
Other place (specify) .............................9
1 Go to
Next
Section
2(H) How far is the Hand washing
station from Toilet?
<Observation>
feet [‘ooo’ if it is inside the cubicle)
3(H) Is there a hand washing devise at
the hand washing station for
washing hands after defecation?
<Observation>
Have a basin ........................................1
Have a pot specified for hand washing after
defecation ..............................................2
No basin or pot ..........................................3
4(H) Presence of soap or detergent (or
other locally used Ash/Mud/Sand)
at the hand washing station?
<Observation>
Yes, Have soap/detergent ...........................1
Yes, Have ash/mud/sand .......................2
No, Nothing for hand washing .....................3
5(H) Is running water (piped supply)
available at the specific place for
hand-washing?
<Observation>
No provision of running water ....................1
Yes, there is provision for running water, but no
water is available during the visit .........2
Running water is available during the visit ....3
38(H)
6(H) How water for hand washing is
stored?
<Observation>
In an open bowls/ container/ bucket ........1
Revered in a protected container ..................2
Water is stored in a protected container fitted
with a tap ...........................................3
Water is not stored ...............................4
7(H) Is there a possibility of hand
touching the water in the
container while taking water for
hand washing (e.g. by mug, other
utensils)?
<Observation>
Yes ..........................................................1
No
...............................................................2
8(H) Who makes decisions for setting
up of the hand washing facilities
which you use?
Landlord/ office (staff quarter) owner ..........1
Tenants ................................................2
Both (if in rented house) .........................3
Faecal Sludge Management – Performance Monitoring Survey 2017
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9(H) Who in the household makes
decisions of the hand washing
facilities which you use?
Women .............................................. 1
Men........................................................ 2
Women and men together..................... 3
10(H) Have you attended any training,
orientation on good hand washing
practice in the past 12 months?
Yes ..................................................1
No ......................................................2
11(H) How did you get the message on
hand washing?
Multiple responses
Radio ............................................1
TV .....................................................2
Newspaper .............................................3
Billboard ...............................................4
Training / orientation .........................5
Family members ....................................7
Educational institute ...........................6
Health centre ........................................8
Others (mention) .....................................9
Faecal Sludge Management
For Households practice open
defecation or have toilet
without covered pit/ septic
tank– GO TO Question 24(F)
1(F) Do you think we need to empty
pit/septic tank?
Yes ....................................1
No ............................................2
1 3(F)
2(F) Please mention reasons why you
think so
Soak in the ground .......................1
Size of pit/ septic tank is too big ..........2
It is connected to drain/ open place ....3
Others (specify) ............................... 9
3(F) Have you ever emptied pit/ septic
tank?
Yes ...........................................1
No .................................................2
Don’t know .....................................8
215(F)
816(F)
4(F) When was the last time? Month ago [mention 98 if it is more
than 8 years; mention 99 if could not
remember]
Ask the following two
questions 5(F) and 6(F) to the
Households have twin pit
latrine with Y-junction
5(F) Did you extract the waste in
order to use as compost fertiliser?
Yes ...........................................1
No .................................................2
don’t know ...................................8
2,87(F)
6(F) How long did you keep the
manure in one pit of a functional
twin-pit latrine separated before
withdrawal?
Duration (months)
If not used manure or do not have twin pit
latrine, mention 99
Faecal Sludge Management – Performance Monitoring Survey 2017
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7(F) How is the pit/ septic tank
emptied?
Manually/ Sweepers ..................1
Combination of manual & mechanical ....2
100% Mechanically .........................3
Self .................................................4
8(F) Who provided the emptying
services?
KCC/ Kushtia/ Jhenaidah Paurashava ....1
CBOs/ NGOs .................................2
Individual Sweeper ...........................3
Self ..............................................4
Other (specify) ..................................9
9(F) Did anyone enter into the septic tank/pit to clean/empty?
Yes ..................................................1
No ............................................2
Don’t remember/ don’ know ................8
2,811(F)
10(F) Why they entered into the pit/ septic tank?
To empty the pit ...........................1
To empty the solid part of the pit/ tank............................................2
To set the Vacu-Tug pipe ................3
Don’t know .................................8
Others (mention) ............................. 9
11(F) Did they empty your septic tank/pit Safely (using mask,
gloves, boot etc. and without contacting their body)?
Yes ...................................................1
No .....................................2
Don’t remember/ don’ know ................8
12(F) Whether the excreta touches the human body while the pit/ septic tank was cleaning?
Yes ...................................................1
No .....................................2
Don’t remember/ don’ know ................8
13(F) How much time did you require to
get the Emptying service Hours
14(F) How much did you pay for
empting last time?
Including all costs – rent, fuel,
labor, etc.
Tk.____________
18(F)
15(F) Why have you never emptied
your pit/septic tank?
It never gets full/overflowing ............1
I don’t have such money ...............2
Other (specify) ..................................9
16(F) Do you know the cost for
emptying your pit/ septic tank? Yes ..................................................1
No ............................................2
218(F)
17(F) How much? Tk.............................
18(F) Do you know where the Emptiers
(sweepers or Vacutug) dump the
sludge after collection?
Don’t know ..................................1
Yes know .................................2 220(F)
19(F) Please mention where they dump.
Dumped in open space near house ........1
Dumped in river/ drain/ watercourse .....2
Dumped in open space away from house
................................................... ....3
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10 | P a g e
Dumped into KCC/ Paurashava specified place
.......................... ....................4
Dumped into treatment plant ..........5
Other (specify) ________________ 9
20(F) Is there any emptying service
provider in your Ward?
Yes ...............................................1
No ..........................................2
Don’t know .....................................8
2,822(F)
21(F) Who are they? Sweeper only ....................................1
Vacutug only ................................2
Both sweeper and Vacutug ..................3
22(F) If it requires to empty your
pit/Septic tank once a year,
would you be willing to pay the
Service Provider to empty it for
you?
Yes ...............................................1
No ..........................................2
224(F)
23(F) If yes, how much would you be
willing to pay each year?
Tk …………………………………………./Year
24(F) Do you know the fecal sludge can
be treated as resource and
reused?
Yes .................................................1
No ..............................................2
2next
section
25(F) Do you use any of the pit
contents for other uses?
Yes .................................................1
No ..............................................2
2next
section
26(F) For what purpose? Fish feed ...................................1
Poultry feed......................................2
Kitchen garden ............................3
Agriculture .......................................4
Producing biogas...........................5
Other (specify) ___________________9
BANGLADESH 2011 WEALTH INDEX QUESTIONNAIRE – PLEASE DO NOT CHANGE THE QUESTION CODES, RESPONSES
OR RESPONSE CODES
Code Question Response codes
URBRUR NOTE WHETHER THE PERSON
LIVES IN AN URBAN OR RURAL
AREA
Urban ………………………
Rural …………………………
1
2
W01 What is the main source of
drinking water for members of
your household?
PIPED WATER
PIPED INTO DWELLING . . . . . . . . . . ….. . 11
PIPED TO YARD/PLOT . . . . . . . . . . . . …. . 12
PUBLIC TAP/STANDPIPE . . . . . . . . . . . ….. 13
TUBE WELL OR BOREHOLE . . . . . . . . . . . . 21
DUG WELL
PROTECTED WELL . . . . . . . . . . . . …. . . . 31
UNPROTECTED WELL . . . . . . . . . . …. . . . 32
WATER FROM SPRING
PROTECTED SPRING . . . . . . . . . . …. . . . 41
UNPROTECTED SPRING . . . . . . . . ….. . . . 42
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RAINWATER . . . . . . . . . . . . . . . . . . . . . . . . . 51
TANKER TRUCK . . . . . . . . . . . . . . . . . . .. . 61
CART WITH SMALL TANK . . . . . . . . . . . . 71
SURFACE WATER (RIVER/DAM/
LAKE/POND/STREAM/CANAL/
IRRIGATION CHANNEL) . . . . . . . . …. . . . 81
BOTTLED WATER . . . . . . . . . . . . . . . . . . . . 91
OTHER 96
W02 What kind of toilet facility
do members of your
household
usually use?
FLUSH OR POUR FLUSH TOILET
FLUSH TO PIPED SEWER SYSTEM . . . 11
FLUSH TO SEPTIC TANK . . . . . . . . . . . . 12
FLUSH TO PIT LATRINE . . . . . . . . . . . . 13
FLUSH TO SOMEWHERE ELSE . . . . . . . . 14
FLUSH, DON'T KNOW WHERE . . . . . . . . 15
PIT LATRINE
VENTILATED IMPROVED PIT LATRINE .. 21
PIT LATRINE WITH SLAB . . . . . . . . . . . . 22
PIT LATRINE WITHOUT SLAB/ OPEN PIT …23
COMPOSTING TOILET . . . . . . . . .. . . . . 31
BUCKET TOILET . . . . . . . . . . . . . . . . . 41
HANGING TOILET/HANGING LATRINE . . ..51
NO FACILITY/BUSH/FIELD . . . . . . . . . 61
OTHER ………………………………………….. 96
W03 Do you share this toilet facility
with other households?
YES ………………………………………………...1
NO .............................................................. 2
Does your household have: YES NO
W04 Electricity? ELECTRICITY . . . . . 1 2
W05 A radio? RADIO . . . . . . . . . . . . 1 2
W06 A television? TELEVISION . . . . . . 1 2
W07 A mobile telephone? MOBILE TELEPHONE . 1 2
W08 A non-mobile telephone? NON-MOBILE PHONE 1 2
W09 A refrigerator? REFRIGERATOR …... 1 2
W10 An almirah/wardrobe? ALMIRAH/WARDROBE 1 2
W11 A table? TABLE……………....... 1 2
W12 A chair? CHAIR ………………... 1 2
W13 An electric fan? ELETRIC FAN………... 1 2
W14 A DVD/VCD player? DVD/VCD PLAYER. .. . 1 2
W15 A water pump? WATER PUMP. . . . . . . 1 2
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W16
What type of fuel does
your household mainly use
for cooking?
ELECTRICITY . . . . . . . . . .. . . . . . . . . 01
LPG . . . . . . . . . . . . . . .. . . . . . . . . . 02
NATURAL GAS . . . . . . . . . .... . . . . . 03
BIOGAS . . . . . . . . . . . . . . . . .. . . . . . 04
KEROSENE . . . . . . . . . . . .. . . . . . . 05
COAL, LIGNITE . . . . . . . . .. . . . . . . . 06
CHARCOAL . . . . . . . . . . . . .. . . . . . 07
WOOD . . . . . . . . . . . . . . . . .. . . . . . 08
STRAW/SHRUBS/GRASS . . .. . . . . 09
AGRICULTURAL CROP . . . .. . . . . . 10
ANIMAL DUNG . . . . . . . . . ... . . . . . . 11
NO FOOD COOKED IN HOUSEHOLD 95
W17 What is the main material of the floor in your household?
NATURAL FLOOR
EARTH/SAND . . . . . . . . . . . . . . . . . . . . 11
RUDIMENTARY FLOOR
WOOD PLANKS . . . . . . . . . . . . . . . . . . 21
PALM/BAMBOO . . . . . . . . . . . . . . . . . . 22
FINISHED FLOOR
PARQUET OR POLISHED WOOD …......... . 31
CERAMIC TILES . . . . . . . . . . . . . . . . . . 33
CEMENT . . . . . . . . . . . . . . . . . . . . . . . . . 34
CARPET . . . . . . . . . . . . . . . . . . . . . . . .. . . . 35
OTHER 96
W18 What is the main material of the roof in your household?
NATURAL ROOFING
NO ROOF . . . . . . . . . . . . . . . . . . . . . . . . . 11
THATCH/PALM LEAF . . . . . . . . . . . . . . . . 12
RUDIMENTARY ROOFING
PALM/BAMBOO . . . . . . . . . . . . . . . . . . . . 22
WOOD PLANKS . . . . . . . . . . . . . . . . . . . . 23
CARDBOARD . . . . . . . . . . . . . . . . . . . . 24
FINISHED ROOFING
TIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
WOOD . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
CERAMIC TILES . . . . . . . . . . . . . . . . . . . . 34
CEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
ROOFING SHINGLES . . . . . . . . . . . . . . . . 36
OTHER 96
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W19 What is the main material of the external walls in your household?
NATURAL WALLS
NO WALLS . . . . . . . . . . . . . . . . . . . . . . . . . 11
CANE/PALM/TRUNKS . . . . . . . . . . . . . . 12
DIRT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
RUDIMENTARY WALLS
BAMBOO WITH MUD . . . . . . . . . . . . . . . . 21
STONE WITH MUD . . . . . . . . . . . . . . . . 22
PLYWOOD . . . . . . . . . . . . . . . . . . . . . . . 24
CARDBOARD . . . . . . . . . . . . . . . . . . . . 25
FINISHED WALLS
TIN . . . . . . . . . . . . . . . . . . . . . . . . . 31
CEMENT (Plaster) . . . . . . . . . . 32
STONE WITH LIME/CEMENT . . . . . . . . . . 33
BRICKS (exposed) . . . . . . . . . . . . . . . . . . . . 34
WOOD PLANKS/SHINGLES . . . . . . . . . . 36
OTHER 96
W20 How many rooms in this household are used for sleeping?
ROOMS _______________________________
Does any member of this household own:
YES NO
W21
An autobike?
AUTOBIKE . . . . . . . . . . . . . . . . . 1 2
W22
A bicycle?
RICKSHAW . . . . . . . . . . . . . . . . 1 2
W23
A rickshaw/van?
BICYCLE . . . . . . . . . . . . . . . . . . 1 2
W24 A motorcycle or motor
scooter/tempo/CNG?
MOTORCYCLE/SCOOTER . . . 1 2
W25 How much land does your
household own (other
than the homestead
land)?
AMOUNT SPECIFY UNIT
IF 95 OR MORE CIRCLE '9995'
ACRES _________________________________
95 OR MORE ACRES . . . . . . . . . . . . . . 95
W26 Does any member of this household have a bank account?
YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
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Telephone number (optional) .............................................
Thank you. Time record: ....................hrs (end of interview)
Signature of Enumerator Signature of Supervisor
Name of Enumerator: Name of Supervisor
W27 How many people live in your household?
PEOPLE ________________________________
W28 Are there any domestic servants (non-family members) working in your household?
YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
W29 Does this household own any livestock, herds, other farm animals, or poultry?
YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
How many of the following animals does this household own?
IF NONE, ENTER '00'.
IF 95 OR MORE, ENTER '95'.
W30 Buffaloes? Cows? BULLS/BUFFALOES . . . . . . . . .
W31 Milk cows or bulls? MILK COWS/BULLS . . . . . . . . . . . .
W32 Goats or sheep? GOAT/SHEEP . . . . . . . . . . . . . . . .
W33 Chickens or ducks? CHICKENS/DUCKS . . . . . . . . . . . .